﻿<%@ Page Language="C#" MasterPageFile="~/travel-insurance/proposalforms/TravelInsuranceProposalMasterPage.master"
    Async="true" Title="Travel Insurance - CompareXpress Singapore" AutoEventWireup="true"
    CodeFile="liberty_proposal_form.aspx.cs" Inherits="travel_insurance_liberty_proposal_form" %>

<%@ Register Src="~/controls/usrPhoneNo.ascx" TagName="usrPhoneNo" TagPrefix="uc1" %>
<%@ Register Src="~/controls/usrDate.ascx" TagName="usrDate" TagPrefix="uc2" %>
<%@ Register Src="~/controls/usrIdType.ascx" TagName="usrIdType" TagPrefix="uc3" %>
<%@ Register Src="~/controls/usrIdNumber.ascx" TagName="usrIdNumber" TagPrefix="uc4" %>
<%@ Register Src="~/controls/usrCompanyLogoByServices.ascx" TagName="usrCompanyLogoByServices"
    TagPrefix="uc5" %>
<%@ Register Src="~/controls/usrSalutation.ascx" TagName="usrSalutation" TagPrefix="uc6" %>
<%@ Register Src="~/controls/usrNationality.ascx" TagName="usrNationality" TagPrefix="uc7" %>
<%@ Register Src="~/controls/usrGender.ascx" TagName="usrGender" TagPrefix="uc8" %>
<%@ Register Src="~/controls/usrRelationship.ascx" TagName="usrRelationship" TagPrefix="uc9" %>
<%@ Register Src="~/controls/usrTraveller.ascx" TagName="usrTraveller" TagPrefix="uc10" %>
<%@ Register Src="~/controls/usrOccupation.ascx" TagName="usrOccupation" TagPrefix="uc11" %>
<%@ Register Src="~/controls/usrMaritalStatus.ascx" TagName="usrMaritalStatus" TagPrefix="uc12" %>
<%@ Register Src="~/controls/usrNoJS.ascx" TagName="usrNoJS" TagPrefix="ucNoJS" %>
<%@ Register Src="~/controls/usrCXAds.ascx" TagName="usrCXAds" TagPrefix="ucAds" %>
<asp:Content ID="Content1" ContentPlaceHolderID="ContentPlaceHolder1" runat="Server">

    <div id="container">
        <div id="nav_top">
            <div class="left pad_8yr">
                <asp:ImageButton ID="imgbtnBackTop" runat="server" ImageUrl="/images/forms_proposal/button/back.png"
                    OnClick="imgbtnBackTop_Click" OnClientClick="return confirm('Are you sure to go back?');" /></div>
            <div class="right pad_8yr">
                <img src="/images/forms_proposal/nav/logo_comparexpress.png" alt="CompareXpress" /></div>
        </div>
        <ucNoJS:usrNoJS ID="usrNoJS1" runat="server" />
        <div id="divLoading">
            <table style="width: 100%; height: 500px">
                <tr>
                    <td align="center" valign="middle">
                        <img src="../../images/loading7.gif" alt="Loading" align="absmiddle" />
                        <span id="divMessage">Please wait...</span><span id="divPgrPercent">0%</span>
                    </td>
                </tr>
            </table>
        </div>
        <asp:ScriptManager ID="ScriptManager1" EnablePartialRendering="true" runat="server">
        </asp:ScriptManager>
        <div id="divContent" style="display: none;">
            <div id="contentBody">
                <div id="header">
                    <div class="seperator">
                    </div>
                    <div class="right" style="width: 240px">
                        <div class="quotesum_button">
                            <img src="/images/forms_proposal/button/quotesum.png" width="240" height="73" alt="Quote Summary" /></div>
                    </div>
                    <h1>
                        Online Travel Insurance Proposal Form -
                        <asp:Label ID="lblProvider" runat="server"></asp:Label></h1>
                    <div class="seperator">
                    </div>
                    <div class="quotesum">
                        <div class="top">
                        </div>
                        <div id="divQuoteSummery" class="body pad_15x">
                            <!-- QUOTE SUMMARY | Start -->
                            <div class="w21per left pad_25xr">
                                <h1>
                                    Quote Reference Number</h1>
                                <p>
                                    <asp:Label ID="lblQref" runat="server"></asp:Label></p>
                                <h1>
                                    Type of Travel:</h1>
                                <p>
                                    <asp:Label ID="lblCoverageType" runat="server"></asp:Label><asp:Label ID="lblCover"
                                        runat="server" Visible="false"></asp:Label><asp:Label ID="lblCoverage" runat="server"
                                            Visible="false"></asp:Label>
                                </p>
                            </div>
                            <div class="w21per left pad_25xr">
                                <h1>
                                    Country Traveling to (one or furthest):</h1>
                                <p>
                                    <asp:Label ID="lblDestination" runat="server"></asp:Label><asp:Label ID="lblTrip"
                                        runat="server" Visible="false"></asp:Label></p>
                                <h1>
                                    Period of Insurance:</h1>
                                <p>
                                    <asp:Label ID="lblPeriodOfCoverage" runat="server"></asp:Label>
                                    <asp:Label ID="lblDuration" runat="server" Visible="false"></asp:Label><asp:Label
                                        ID="lblStart" runat="server" Visible="false"></asp:Label><asp:Label ID="lblEnd" runat="server"
                                            Visible="false"></asp:Label>
                                </p>
                            </div>
                            <div class="w21per left pad_25xr">
                                <h1>
                                    Type of Plan:</h1>
                                <p>
                                    <asp:Label ID="lblPolicyType" runat="server"></asp:Label><asp:Label ID="lblAdultAge"
                                        runat="server" Visible="false"></asp:Label><asp:Label ID="lblChildAge" runat="server"
                                            Visible="false"></asp:Label>
                                </p>
                                <h1>
                                    No. of Traveller/s:</h1>
                                <p>
                                    <asp:Label ID="lblNoOfTravellers" runat="server"></asp:Label><input id="inNoOfTravellers"
                                        runat="server" type="hidden" /></p>
                                <div style="display: none;">
                                    <asp:TextBox ID="txtNoofAdults" runat="server" Text="0"></asp:TextBox>
                                    <asp:TextBox ID="txtNoofChilds" runat="server" Text="0"></asp:TextBox>
                                </div>
                            </div>

                            <script type="text/javascript">
                                IncreaseProgress(20);
                            </script>

                            <div class="w21per left pad_25xr">
                                <h1>
                                    &nbsp;</h1>
                                <p>
                                    &nbsp;</p>
                                <h1>
                                    Total Premium (w/ GST):</h1>
                                <p>
                                    <asp:Label ID="lblTotalPremium" runat="server"></asp:Label></p>
                            </div>
                            <!-- QUOTE SUMMARY | End   -->
                        </div>
                        <div class="bottom">
                        </div>
                    </div>
                </div>
                <div class="seperator">
                </div>
                <div id="body">
                </div>
                <div id="divValidationSummary">
                    <asp:ValidationSummary ID="vstravelinsurance" runat="server" CssClass="errorSummary"
                        ValidationGroup="travel_insurance" HeaderText="Oops please complete the form" />
                </div>
                <div class="form">
                    <div class="top">
                        <div class="left">
                            <div class="pad_10t pad_35xl white">
                                Online Travel Insurance Proposal Form</div>
                        </div>
                        <div class="right">
                        </div>
                    </div>
                    <div class="body">
                        <div class="inner">
                            <div class="pad_20x10y">
                                <div class="norm">
                                    <div class="top_t">
                                    </div>
                                    <div class="body">
                                        <div class="pad_15x">
                                            <p>
                                                Statement pursuant to Section 25(5) of the Insurance Act (Cap. 142) ( or any subsequent
                                                amendments thereof) - You are to disclose in this proposal form fully and faithfully
                                                all facts which you know, otherwise the policy issued hereunder may be void.<br />
                                                <br />
                                                <b>Important</b>: Main insured must be a Singapore resident, Singapore PR or Work
                                                Permit Holder and be at least 18 years of age.</p>
                                        </div>
                                    </div>
                                    <div class="bottom">
                                    </div>
                                </div>
                                <div class="seperator">
                                </div>
                                <div class="hilite">
                                    <div class="top">
                                    </div>
                                    <div class="body_in pad_15x">
                                        <h1>
                                            Customer Personal Details</h1>
                                        <div class="seperator">
                                        </div>
                                        <div class="w49per left">
                                            <div>
                                                <div class="w180 left align_right pad_6t pad_7xr">
                                                    <span class="red">*</span> Full Name:</div>
                                                <div class="left">
                                                    <asp:TextBox ID="txtFullname" runat="server" Width="200px"></asp:TextBox>
                                                    <asp:RequiredFieldValidator ID="rfvFullname" runat="server" ControlToValidate="txtFullname"
                                                        CssClass="validationErrorControl" ErrorMessage="" ValidationGroup="travel_insurance"></asp:RequiredFieldValidator>
                                                </div>
                                            </div>
                                            <div class="h10">
                                            </div>
                                            <div>
                                                <div class="w180 left align_right pad_6t pad_7xr">
                                                    <span class="red">*</span> NRIC/Passport No.:</div>
                                                <div class="left">
                                                    <uc4:usrIdNumber ID="ddlNRIC" runat="server" ValidationGroup="travel_insurance" />
                                                    <%--<asp:TextBox ID="txtNRICPass" runat="server" Width="200px"></asp:TextBox>
                                                    <asp:RequiredFieldValidator ID="rfvNRICPass" runat="server" ControlToValidate="txtNRICPass"
                                                        CssClass="validationErrorControl" ErrorMessage="" ValidationGroup="travel_insurance"></asp:RequiredFieldValidator>--%>
                                                </div>
                                            </div>
                                            <div class="h10">
                                            </div>
                                            <div>
                                                <div class="w180 left align_right pad_6t pad_7xr">
                                                    <span class="red">*</span> E-mail:</div>
                                                <div class="left">
                                                    <asp:TextBox ID="txtEmailAddress" runat="server" Width="200px"></asp:TextBox>
                                                    <asp:RequiredFieldValidator ID="rfvEmailAddress" runat="server" ControlToValidate="txtEmailAddress"
                                                        Display="Dynamic" CssClass="validationErrorControl" ErrorMessage="" ValidationGroup="travel_insurance"></asp:RequiredFieldValidator>
                                                    <asp:RegularExpressionValidator ID="revEmailAddress" runat="server" ControlToValidate="txtEmailAddress"
                                                        CssClass="validationErrorControl" ErrorMessage="" ValidationExpression="\w+([-+.']\w+)*@\w+([-.]\w+)*\.\w+([-.]\w+)*"
                                                        ValidationGroup="travel_insurance"></asp:RegularExpressionValidator>
                                                </div>
                                            </div>
                                            <div style="display: none;">
                                                <div class="w180 left align_right pad_6t pad_7xr">
                                                    <span class="red">*</span> Date of Birth:</div>
                                                <div class="left">
                                                    <uc2:usrDate ID="usrDOB" runat="server" ValidationGroup="travel_insurance" IsRequired="True"
                                                        IsEnabled="false" />
                                                </div>
                                            </div>
                                            <div class="h10">
                                            </div>
                                            <div>
                                                <div class="w180 left align_right pad_6t pad_7xr">
                                                    <span class="red">*</span> Gender:</div>
                                                <div class="left">
                                                    <uc8:usrGender ID="usrGender" ValidationGroup="travel_insurance" runat="server" IsEnabled="true" />
                                                </div>
                                            </div>
                                            <div class="h10">
                                            </div>
                                            <div>
                                                <div class="w180 left align_right pad_6t pad_7xr">
                                                    <span class="red">*</span> Marital Status:</div>
                                                <div class="left">
                                                    <uc12:usrMaritalStatus ID="ddlMaritalStatus" runat="server" IsEnabled="true" ValidationGroup="travel_insurance"
                                                        ErrorMessage="" />
                                                </div>
                                            </div>
                                        </div>
                                        <div class="w49per right">
                                           <%-- <asp:UpdatePanel ID="UpdatePanel1" runat="server">
                                                <ContentTemplate>--%>
                                                    <div id="divPostCode">
                                                        <div class="w180 left align_right pad_6t pad_7xr">
                                                            <span class="red">*</span> Postcode:
                                                        </div>
                                                        <asp:TextBox ID="txtPostCode" size="8" onkeypress="restrictToNumbers(event)" runat="server" MaxLength="6" Width="80px"></asp:TextBox>
                                                       <%-- <asp:ImageButton ID="ibtPostCode" runat="server" CssClass="button" align="absmiddle"
                                                            OnClick="ibtPostCode_Click" Width="108" ValidationGroup="PostCode" AlternateText="Get Address"
                                                            ImageUrl="~/images/forms_proposal/button/getaddress.png" />
                                                        <asp:UpdateProgress runat="server" ID="uplUpProgress" DisplayAfter="500">
                                                            <ProgressTemplate>
                                                                <span style="position: absolute; text-align: right; width: 390px;">
                                                                    <img src="../../images/loading7.gif" id="ldPostCode" alt="loading" />
                                                                </span>
                                                            </ProgressTemplate>
                                                        </asp:UpdateProgress>--%>
                                                        <asp:RequiredFieldValidator ID="rfvPCode" runat="server" CssClass="validationErrorControl"
                                                            Display="Dynamic" ErrorMessage="" ValidationGroup="PostCode" ControlToValidate="txtPostCode"></asp:RequiredFieldValidator>
                                                        <asp:RegularExpressionValidator ID="revPCode" runat="server" CssClass="validationErrorControl"
                                                            Display="Dynamic" ErrorMessage="" ValidationGroup="PostCode" ValidationExpression="[0-9]{6}"
                                                            ControlToValidate="txtPostCode"></asp:RegularExpressionValidator>
                                                        <asp:RequiredFieldValidator ID="rfvPostCode" runat="server" CssClass="validationErrorControl"
                                                            Display="Dynamic" ErrorMessage="" ValidationGroup="travel_insurance" ControlToValidate="txtPostCode"></asp:RequiredFieldValidator>
                                                        <asp:RegularExpressionValidator ID="revPostCode" runat="server" CssClass="validationErrorControl"
                                                            Display="Dynamic" ErrorMessage="" ValidationGroup="travel_insurance" ValidationExpression="[0-9]{6}"
                                                            ControlToValidate="txtPostCode"></asp:RegularExpressionValidator>
                                                    </div>
                                                    <div runat="server" visible="false" id="divAddressList">
                                                        <div class="h10">
                                                        </div>
                                                        <div class="w180 left align_right pad_6t pad_7xr">
                                                            Please choose your address
                                                        </div>
                                                        <asp:DropDownList ID="ddlAddressList" Width="320px" AutoPostBack="true" runat="server"
                                                            OnSelectedIndexChanged="ddlAddressList_SelectedIndexChanged">
                                                        </asp:DropDownList>
                                                    </div>
                                              <%--  </ContentTemplate>
                                            </asp:UpdatePanel>--%>
                                            <div class="h10">
                                            </div>
                                            <div id="divUnitNo">
                                                <div class="w180 left align_right pad_6t pad_7xr">
                                                    <span class="red">*</span> Unit Number:
                                                </div>
                                                <asp:TextBox ID="txtUnit1" MaxLength="10" runat="server" size="8"></asp:TextBox>-
                                                <asp:RequiredFieldValidator ID="rfvUnit1" runat="server" CssClass="validationErrorControl"
                                                    ErrorMessage="" ValidationGroup="travel_insurance" ControlToValidate="txtUnit1"></asp:RequiredFieldValidator>
                                                <asp:TextBox ID="txtUnit2" MaxLength="10" runat="server" size="8"></asp:TextBox>
                                                <asp:RequiredFieldValidator ID="rfvUnit2" runat="server" CssClass="validationErrorControl"
                                                    ErrorMessage="" ValidationGroup="travel_insurance" ControlToValidate="txtUnit2"></asp:RequiredFieldValidator>
                                            </div>
                                            <div class="h10">
                                            </div>
                                            <asp:UpdatePanel ID="UpdatePanel2" runat="server">
                                                <ContentTemplate>
                                                    <div id="divPCAddress">
                                                        <div class="w180 left align_right pad_6t pad_7xr">
                                                            <span class="red">*</span> Address:
                                                        </div>
                                                        <span id="divAddress"></span>
                                                        <asp:TextBox ID="txtAddress" runat="server" TextMode="MultiLine" MaxLength="120"
                                                            Width="200px"></asp:TextBox>
                                                        <asp:RequiredFieldValidator ID="rfvAddress" runat="server" CssClass="validationErrorControl"
                                                            ErrorMessage="" ValidationGroup="travel_insurance" ControlToValidate="txtAddress"></asp:RequiredFieldValidator>
                                                    </div>
                                                </ContentTemplate>
                                            </asp:UpdatePanel>
                                            <div class="h10">
                                            </div>
                                            <div>
                                                <div class="w180 left align_right pad_6t pad_7xr">
                                                    <span class="red">*</span> Nationality:</div>
                                                <div class="left">
                                                    <uc7:usrNationality ID="ddlNationality" runat="server" ErrorMessage="" ValidationGroup="travel_insurance" />
                                                </div>
                                            </div>
                                            <div class="h10">
                                            </div>
                                            <div>
                                                <div class="w180 left align_right pad_6t pad_7xr">
                                                    <span class="red">*</span> Occupation:</div>
                                                <div class="left">
                                                    <uc11:usrOccupation ID="usrOccupation" ValidationGroup="travel_insurance" runat="server"
                                                        IsEnabled="true" />
                                                </div>
                                            </div>
                                        </div>
                                        <div class="clear">
                                        </div>
                                        <div class="h10">
                                        </div>
                                        <div style="border: 1px solid #ccc; width: 912px; background: #d2d2d2;">
                                            <div class="h10">
                                            </div>
                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                Contact Info:</div>
                                            <div class="w190 note left">
                                                <span class="red">*</span> Mobile Number<br />
                                                <uc1:usrPhoneNo ID="txtMobileNo" IsEnabled="true" IsRequired="true" PhoneNoRequireErrorMessage="Require mobile number."
                                                    PhoneNoErrorMessage="Mobile phone number should 8 digits." PhoneNoValidErrorMessage="Invalid mobile phone number."
                                                    runat="server" ValidationGroup="travel_insurance" />
                                            </div>
                                            <div class="w190 note left">
                                                Home Phone Number<br />
                                                <uc1:usrPhoneNo ID="txtResidentialPhoneNo" runat="server" ValidationGroup="travel_insurance"
                                                    IsRequired="False" PhoneNoValidErrorMessage="Invalid home phone number." />
                                            </div>
                                            <div class="w190 note left">
                                                Office Phone Number<br />
                                                <uc1:usrPhoneNo ID="txtOfficeNo" runat="server" ValidationGroup="travel_insurance"
                                                    IsRequired="False" />
                                            </div>
                                            <div class="h10">
                                            </div>
                                        </div>
                                    </div>
                                    <div class="bottom">
                                    </div>
                                </div>
                                <div class="seperator">
                                </div>
                                <div class="hilite" id="divInsuredDetails">
                                    <div class="top">
                                    </div>
                                    <div class="body_in pad_15x">
                                        <h1>
                                            Insured Details</h1>
                                        <div class="seperator">
                                        </div>
                                        <div id="divInsurerNameConfirm">
                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                <span class="red"></span>
                                            </div>
                                            <div class="left">
                                                <asp:CheckBox ID="chkInsurerNameAgreed" onclick="CheckedChanged();" runat="server"
                                                    Text="" />
                                                <span><b>Proposer Details same as Insured Details.</b></span>
                                                <div style="display: none">
                                                    <asp:TextBox ID="txtInsurerNameSame" runat="server" />

                                                    <script type="text/javascript">
                                                        function CheckedChanged() {
                                                            //alert('rdoYesOffFDCom');
                                                            var ctrlTxt = document.getElementById('<%=txtInsurerNameSame.ClientID%>');
                                                            var ctrlY = document.getElementById('<%=chkInsurerNameAgreed.ClientID%>');
                                                            if (ctrlY.checked == true) {
                                                                ShowHideDiv('divInsurer', false);
                                                                ctrlTxt.value = '1';
                                                                ValInsurerDetails(false);
                                                            }
                                                            else {

                                                                ShowHideDiv('divInsurer', true);
                                                                ctrlTxt.value = '0';
                                                                ValInsurerDetails(true);
                                                            }
                                                        }

                                                        function ValInsurerDetails(varOnOff) {

                                                            ValidatorEnable(document.getElementById('<%=rfvNameInsured.ClientID%>'), varOnOff);
                                                            ValidatorEnable(document.getElementById('<%=revNameInsured.ClientID%>'), varOnOff);
                                                            ValidatorEnable(document.getElementById('<%=ddlNRICInsured.ClientID%>' + "_csvIdPrefix"), varOnOff);
                                                            ValidatorEnable(document.getElementById('<%=ddlNRICInsured.ClientID%>' + "_rfvIdNumber"), varOnOff);
                                                            ValidatorEnable(document.getElementById('<%=ddlNRICInsured.ClientID%>' + "_revIdNumberLength"), varOnOff);
                                                            ValidatorEnable(document.getElementById('<%=ddlNRICInsured.ClientID%>' + "_csvIdNumber"), varOnOff);
                                                            ValidatorEnable(document.getElementById('<%=ddlNRICInsured.ClientID%>' + "_csvIdPostfix"), varOnOff);
                                                            IsEnableDateValidation('<%=usrDOBInsured.ClientID%>', varOnOff);
                                                            ValidatorEnable(document.getElementById('<%=ddlGenderInsured.ClientID%>' + "_rfvGender"), varOnOff);
                                                            ValidatorEnable(document.getElementById('<%=ddlNationalityInsured.ClientID%>' + "_rfvNationality"), varOnOff);
                                                            //ValidatorEnable(document.getElementById('<=ddlRelationshipInsured.ClientID>' + "_rfvRelationship"), varOnOff);
                                                            ValidatorEnable(document.getElementById('<%=ddlOccupationInsured.ClientID%>' + "_rfvOccupation"), varOnOff);
                                                        }
                                                    </script>

                                                </div>
                                            </div>
                                        </div>
                                        <div class="seperator">
                                        </div>
                                        <div id="divInsurer" style="display: block;">
                                            <div class="w49per left">
                                                <div id="divNameInsured">
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <span class="red">*</span> Full Name:</div>
                                                    <div class="left pad_6t">
                                                        <asp:TextBox ID="txtNameInsured" MaxLength="50" runat="server" Width="200px"></asp:TextBox>
                                                        <asp:RequiredFieldValidator ID="rfvNameInsured" runat="server" CssClass="validationErrorControl"
                                                            ErrorMessage="" ValidationGroup="travel_insurance" ControlToValidate="txtNameInsured"></asp:RequiredFieldValidator>
                                                        <asp:RegularExpressionValidator ID="revNameInsured" runat="server" ControlToValidate="txtNameInsured"
                                                            ValidationExpression="^[a-zA-Z''-'\s]{1,50}$" ValidationGroup="travel_insurance"
                                                            CssClass="validationErrorControl" Text="" ErrorMessage=""></asp:RegularExpressionValidator>
                                                    </div>
                                                </div>
                                                <div class="h10">
                                                </div>
                                                <div>
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <span class="red">*</span> NRIC:</div>
                                                    <div class="left">
                                                        <uc4:usrIdNumber ID="ddlNRICInsured" runat="server" ValidationGroup="travel_insurance" />
                                                        <%--<asp:TextBox ID="txtNRICInsured" runat="server" Width="200px"></asp:TextBox>
                                                        <asp:RequiredFieldValidator ID="rfvNRICInsured" runat="server" ControlToValidate="txtNRICInsured"
                                                            CssClass="validationErrorControl" ErrorMessage="" ValidationGroup="travel_insurance"></asp:RequiredFieldValidator>--%>
                                                    </div>
                                                </div>
                                                <div class="h10">
                                                </div>
                                                <div>
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <span class="red">*</span> Date of Birth:</div>
                                                    <div class="left">
                                                        <uc2:usrDate ID="usrDOBInsured" runat="server" ValidationGroup="travel_insurance"
                                                            IsRequired="True" IsEnabled="false" />
                                                    </div>
                                                </div>
                                            </div>
                                            <div class="w49per right">
                                                <div>
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <span class="red">*</span> Nationality:</div>
                                                    <div class="left">
                                                        <uc7:usrNationality ID="ddlNationalityInsured" runat="server" ErrorMessage="" ValidationGroup="travel_insurance" />
                                                    </div>
                                                </div>
                                                <%-- <div class="h10"></div>
                                                <div>
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <span class="red">*</span> Relation Ship:</div>
                                                    <div class="left">
                                                        <uc9:usrRelationship ID="ddlRelationshipInsured" runat="server" ErrorMessage="" ValidationGroup="travel_insurance" />
                                                    </div>
                                                </div>--%>
                                                <div class="h10">
                                                </div>
                                                <div>
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <span class="red">*</span> Occupation:</div>
                                                    <div class="left">
                                                        <uc11:usrOccupation ID="ddlOccupationInsured" ValidationGroup="travel_insurance"
                                                            runat="server" IsEnabled="true" />
                                                    </div>
                                                </div>
                                                <div class="h10">
                                                </div>
                                                <div>
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <span class="red">*</span> Gender:</div>
                                                    <div class="left">
                                                        <uc8:usrGender ID="ddlGenderInsured" ValidationGroup="travel_insurance" runat="server" />
                                                    </div>
                                                </div>
                                                <div class="clear">
                                                </div>
                                            </div>
                                        </div>
                                        <asp:Panel ID="pnlAdult" runat="server">
                                            <div id="divAdult2orSpouse">
                                                <h1>
                                                    Spouse (or) Adult 2</h1>
                                                <div class="h10">
                                                </div>
                                                <div class="w49per left">
                                                    <div id="divNameAdult2orSpouse">
                                                        <div class="w180 left align_right pad_6t pad_7xr">
                                                            <span class="red">*</span> Full Name:</div>
                                                        <div class="left pad_6t">
                                                            <asp:TextBox ID="txtNameAdult2orSpouse" MaxLength="50" runat="server" Width="200px"></asp:TextBox>
                                                            <asp:RequiredFieldValidator ID="rfvNameAdult2orSpouse" runat="server" CssClass="validationErrorControl"
                                                                ErrorMessage="" ValidationGroup="travel_insurance" ControlToValidate="txtNameAdult2orSpouse"></asp:RequiredFieldValidator>
                                                            <asp:RegularExpressionValidator ID="revNameAdult2orSpouse" runat="server" ControlToValidate="txtNameAdult2orSpouse"
                                                                ValidationExpression="^[a-zA-Z''-'\s]{1,50}$" ValidationGroup="travel_insurance"
                                                                CssClass="validationErrorControl" Text="" ErrorMessage=""></asp:RegularExpressionValidator>
                                                        </div>
                                                    </div>
                                                    <div class="h10">
                                                    </div>
                                                    <div>
                                                        <div class="w180 left align_right pad_6t pad_7xr">
                                                            <span class="red">*</span> NRIC:</div>
                                                        <div class="left">
                                                            <uc4:usrIdNumber ID="ddlNRICAdult2orSpouse" runat="server" ValidationGroup="travel_insurance" />
                                                            <%--<asp:TextBox ID="txtNRICAdult2orSpouse" runat="server" Width="200px"></asp:TextBox>
                                                        <asp:RequiredFieldValidator ID="rfvNRICAdult2orSpouse" runat="server" ControlToValidate="txtNRICAdult2orSpouse"
                                                            CssClass="validationErrorControl" ErrorMessage="" ValidationGroup="travel_insurance"></asp:RequiredFieldValidator>--%>
                                                        </div>
                                                    </div>
                                                    <div class="h10">
                                                    </div>
                                                    <div>
                                                        <div class="w180 left align_right pad_6t pad_7xr">
                                                            <span class="red">*</span> Date of Birth:</div>
                                                        <div class="left">
                                                            <uc2:usrDate ID="usrDOBAdult2orSpouse" runat="server" ValidationGroup="travel_insurance"
                                                                IsRequired="True" IsEnabled="false" />
                                                        </div>
                                                    </div>
                                                    <div class="h10">
                                                    </div>
                                                    <div>
                                                        <div class="w180 left align_right pad_6t pad_7xr">
                                                            <span class="red">*</span> Gender:</div>
                                                        <div class="left">
                                                            <uc8:usrGender ID="ddlGenderAdult2orSpouse" ValidationGroup="travel_insurance" runat="server" />
                                                        </div>
                                                    </div>
                                                </div>
                                                <div class="w49per right">
                                                    <div>
                                                        <div class="w180 left align_right pad_6t pad_7xr">
                                                            <span class="red">*</span> Nationality:</div>
                                                        <div class="left">
                                                            <uc7:usrNationality ID="ddlNationalityAdult2orSpouse" runat="server" ErrorMessage=""
                                                                ValidationGroup="travel_insurance" />
                                                        </div>
                                                    </div>
                                                    <div class="h10">
                                                    </div>
                                                    <div>
                                                        <div class="w180 left align_right pad_6t pad_7xr">
                                                            <span class="red">*</span> Relation Ship:</div>
                                                        <div class="left">
                                                            <uc9:usrRelationship ID="ddlRelationshipAdult2orSpouse" runat="server" ErrorMessage=""
                                                                ValidationGroup="travel_insurance" />
                                                        </div>
                                                    </div>
                                                    <div class="h10">
                                                    </div>
                                                    <div>
                                                        <div class="w180 left align_right pad_6t pad_7xr">
                                                            <span class="red">*</span> Occupation:</div>
                                                        <div class="left">
                                                            <uc11:usrOccupation ID="ddlOccupationAdult2orSpouse" ValidationGroup="travel_insurance"
                                                                runat="server" IsEnabled="true" />
                                                        </div>
                                                    </div>
                                                    <div class="clear">
                                                    </div>
                                                </div>
                                            </div>
                                        </asp:Panel>
                                    </div>
                                    <div class="bottom">
                                    </div>
                                </div>
                                <div class="seperator">
                                </div>
                                <asp:Panel ID="pnlChildsParticulars" runat="server" Width="100%">
                                    <div class="hilite" id="divChilds">
                                        <div class="top">
                                        </div>
                                        <div class="body_in pad_15x">
                                            <h1>
                                                Child's Details</h1>
                                            <asp:Panel ID="pnlChild1" runat="server" Width="100%">
                                                <div class="seperator">
                                                </div>
                                                <div>
                                                    <h3>
                                                        Child 1</h3>
                                                    <div class="h10">
                                                    </div>
                                                    <div class="w43per left">
                                                        <div id="divChildName1">
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Name:</div>
                                                            <div class="left pad_6t">
                                                                <asp:TextBox ID="txtChildName1" MaxLength="50" runat="server" Width="200px"></asp:TextBox>
                                                                <asp:RequiredFieldValidator ID="rfvChildName1" runat="server" CssClass="validationErrorControl"
                                                                    ErrorMessage="" ValidationGroup="travel_insurance" ControlToValidate="txtChildName1"></asp:RequiredFieldValidator>
                                                                <asp:RegularExpressionValidator ID="revChildName1" runat="server" ControlToValidate="txtChildName1"
                                                                    ValidationExpression="^[a-zA-Z''-'\s]{1,50}$" ValidationGroup="travel_insurance"
                                                                    CssClass="validationErrorControl" Text="" ErrorMessage=""></asp:RegularExpressionValidator>
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> NRIC:</div>
                                                            <div class="left">
                                                                <uc4:usrIdNumber ID="ddlChildNRIC1" runat="server" ValidationGroup="travel_insurance" />
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Date of Birth:</div>
                                                            <div class="left">
                                                                <uc2:usrDate ID="ddlChildDOB1" runat="server" ValidationGroup="travel_insurance"
                                                                    IsEnabled="false" />
                                                            </div>
                                                        </div>
                                                    </div>
                                                    <div class="w56per left">
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Nationality:</div>
                                                            <div class="left">
                                                                <uc7:usrNationality ID="ddlChildNationality1" runat="server" ErrorMessage="" ValidationGroup="travel_insurance" />
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Relation Ship:</div>
                                                            <div class="left">
                                                                <uc9:usrRelationship ID="ddlChildRelationship1" runat="server" ErrorMessage="" ValidationGroup="travel_insurance" />
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Gender:</div>
                                                            <div class="left">
                                                                <uc8:usrGender ID="ddlGenderChild1" ValidationGroup="travel_insurance" runat="server" />
                                                            </div>
                                                        </div>
                                                        <div class="clear">
                                                        </div>
                                                    </div>
                                                </div>
                                            </asp:Panel>
                                            <asp:Panel ID="pnlChild2" runat="server" Width="100%">
                                                <div class="seperator">
                                                </div>
                                                <div>
                                                    <h3>
                                                        Child 2</h3>
                                                    <div class="h10">
                                                    </div>
                                                    <div class="w43per left">
                                                        <div id="divChildName2">
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Name:</div>
                                                            <div class="left pad_6t">
                                                                <asp:TextBox ID="txtChildName2" MaxLength="50" runat="server" Width="200px"></asp:TextBox>
                                                                <asp:RequiredFieldValidator ID="rfvChildName2" runat="server" CssClass="validationErrorControl"
                                                                    ErrorMessage="" ValidationGroup="travel_insurance" ControlToValidate="txtChildName2"></asp:RequiredFieldValidator>
                                                                <asp:RegularExpressionValidator ID="revChildName2" runat="server" ControlToValidate="txtChildName2"
                                                                    ValidationExpression="^[a-zA-Z''-'\s]{1,50}$" ValidationGroup="travel_insurance"
                                                                    CssClass="validationErrorControl" Text="" ErrorMessage=""></asp:RegularExpressionValidator>
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> NRIC:</div>
                                                            <div class="left">
                                                                <uc4:usrIdNumber ID="ddlChildNRIC2" runat="server" ValidationGroup="travel_insurance" />
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Date of Birth:</div>
                                                            <div class="left">
                                                                <uc2:usrDate ID="ddlChildDOB2" runat="server" ValidationGroup="travel_insurance"
                                                                    IsEnabled="false" />
                                                            </div>
                                                        </div>
                                                    </div>
                                                    <div class="w56per left">
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Nationality:</div>
                                                            <div class="left">
                                                                <uc7:usrNationality ID="ddlChildNationality2" runat="server" ErrorMessage="" ValidationGroup="travel_insurance" />
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Relation Ship:</div>
                                                            <div class="left">
                                                                <uc9:usrRelationship ID="ddlChildRelationship2" runat="server" ErrorMessage="" ValidationGroup="travel_insurance" />
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Gender:</div>
                                                            <div class="left">
                                                                <uc8:usrGender ID="ddlGenderChild2" ValidationGroup="travel_insurance" runat="server" />
                                                            </div>
                                                        </div>
                                                        <div class="clear">
                                                        </div>
                                                    </div>
                                                </div>
                                            </asp:Panel>

                                            <script type="text/javascript">
                                                IncreaseProgress(50);
                                            </script>

                                            <asp:Panel ID="pnlChild3" runat="server" Width="100%">
                                                <div class="seperator">
                                                </div>
                                                <div>
                                                    <h3>
                                                        Child 3</h3>
                                                    <div class="h10">
                                                    </div>
                                                    <div class="w43per left">
                                                        <div id="divChildName3">
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Name:</div>
                                                            <div class="left pad_6t">
                                                                <asp:TextBox ID="txtChildName3" MaxLength="50" runat="server" Width="200px"></asp:TextBox>
                                                                <asp:RequiredFieldValidator ID="rfvChildName3" runat="server" CssClass="validationErrorControl"
                                                                    ErrorMessage="" ValidationGroup="travel_insurance" ControlToValidate="txtChildName3"></asp:RequiredFieldValidator>
                                                                <asp:RegularExpressionValidator ID="revChildName3" runat="server" ControlToValidate="txtChildName3"
                                                                    ValidationExpression="^[a-zA-Z''-'\s]{1,50}$" ValidationGroup="travel_insurance"
                                                                    CssClass="validationErrorControl" Text="" ErrorMessage=""></asp:RegularExpressionValidator>
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> NRIC:</div>
                                                            <div class="left">
                                                                <uc4:usrIdNumber ID="ddlChildNRIC3" runat="server" ValidationGroup="travel_insurance" />
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Date of Birth:</div>
                                                            <div class="left">
                                                                <uc2:usrDate ID="ddlChildDOB3" runat="server" ValidationGroup="travel_insurance"
                                                                    IsEnabled="false" />
                                                            </div>
                                                        </div>
                                                    </div>
                                                    <div class="w56per left">
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Nationality:</div>
                                                            <div class="left">
                                                                <uc7:usrNationality ID="ddlChildNationality3" runat="server" ErrorMessage="" ValidationGroup="travel_insurance" />
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Relation Ship:</div>
                                                            <div class="left">
                                                                <uc9:usrRelationship ID="ddlChildRelationship3" runat="server" ErrorMessage="" ValidationGroup="travel_insurance" />
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Gender:</div>
                                                            <div class="left">
                                                                <uc8:usrGender ID="ddlGenderChild3" ValidationGroup="travel_insurance" runat="server" />
                                                            </div>
                                                        </div>
                                                        <div class="clear">
                                                        </div>
                                                    </div>
                                                </div>
                                            </asp:Panel>
                                            <asp:Panel ID="pnlChild4" runat="server" Width="100%">
                                                <div class="seperator">
                                                </div>
                                                <div>
                                                    <h3>
                                                        Child 4</h3>
                                                    <div class="h10">
                                                    </div>
                                                    <div class="w43per left">
                                                        <div id="divChildName4">
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Name:</div>
                                                            <div class="left pad_6t">
                                                                <asp:TextBox ID="txtChildName4" MaxLength="50" runat="server" Width="200px"></asp:TextBox>
                                                                <asp:RequiredFieldValidator ID="rfvChildName4" runat="server" CssClass="validationErrorControl"
                                                                    ErrorMessage="" ValidationGroup="travel_insurance" ControlToValidate="txtChildName4"></asp:RequiredFieldValidator>
                                                                <asp:RegularExpressionValidator ID="revChildName4" runat="server" ControlToValidate="txtChildName4"
                                                                    ValidationExpression="^[a-zA-Z''-'\s]{1,50}$" ValidationGroup="travel_insurance"
                                                                    CssClass="validationErrorControl" Text="" ErrorMessage=""></asp:RegularExpressionValidator>
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> NRIC:</div>
                                                            <div class="left">
                                                                <uc4:usrIdNumber ID="ddlChildNRIC4" runat="server" ValidationGroup="travel_insurance" />
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Date of Birth:</div>
                                                            <div class="left">
                                                                <uc2:usrDate ID="ddlChildDOB4" runat="server" ValidationGroup="travel_insurance"
                                                                    IsEnabled="false" />
                                                            </div>
                                                        </div>
                                                    </div>
                                                    <div class="w56per left">
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Nationality:</div>
                                                            <div class="left">
                                                                <uc7:usrNationality ID="ddlChildNationality4" runat="server" ErrorMessage="" ValidationGroup="travel_insurance" />
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Relation Ship:</div>
                                                            <div class="left">
                                                                <uc9:usrRelationship ID="ddlChildRelationship4" runat="server" ErrorMessage="" ValidationGroup="travel_insurance" />
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Gender:</div>
                                                            <div class="left">
                                                                <uc8:usrGender ID="ddlGenderChild4" ValidationGroup="travel_insurance" runat="server" />
                                                            </div>
                                                        </div>
                                                        <div class="clear">
                                                        </div>
                                                    </div>
                                                </div>
                                            </asp:Panel>
                                            <asp:Panel ID="pnlChild5" runat="server" Width="100%">
                                                <div class="seperator">
                                                </div>
                                                <div>
                                                    <h3>
                                                        Child 5</h3>
                                                    <div class="h10">
                                                    </div>
                                                    <div class="w43per left">
                                                        <div id="divChildName5">
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Name:</div>
                                                            <div class="left pad_6t">
                                                                <asp:TextBox ID="txtChildName5" MaxLength="50" runat="server" Width="200px"></asp:TextBox>
                                                                <asp:RequiredFieldValidator ID="rfvChildName5" runat="server" CssClass="validationErrorControl"
                                                                    ErrorMessage="" ValidationGroup="travel_insurance" ControlToValidate="txtChildName5"></asp:RequiredFieldValidator>
                                                                <asp:RegularExpressionValidator ID="revChildName5" runat="server" ControlToValidate="txtChildName5"
                                                                    ValidationExpression="^[a-zA-Z''-'\s]{1,50}$" ValidationGroup="travel_insurance"
                                                                    CssClass="validationErrorControl" Text="" ErrorMessage=""></asp:RegularExpressionValidator>
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> NRIC:</div>
                                                            <div class="left">
                                                                <uc4:usrIdNumber ID="ddlChildNRIC5" runat="server" ValidationGroup="travel_insurance" />
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Date of Birth:</div>
                                                            <div class="left">
                                                                <uc2:usrDate ID="ddlChildDOB5" runat="server" ValidationGroup="travel_insurance"
                                                                    IsEnabled="false" />
                                                            </div>
                                                        </div>
                                                    </div>
                                                    <div class="w56per left">
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Nationality:</div>
                                                            <div class="left">
                                                                <uc7:usrNationality ID="ddlChildNationality5" runat="server" ErrorMessage="" ValidationGroup="travel_insurance" />
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Relation Ship:</div>
                                                            <div class="left">
                                                                <uc9:usrRelationship ID="ddlChildRelationship5" runat="server" ErrorMessage="" ValidationGroup="travel_insurance" />
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Gender:</div>
                                                            <div class="left">
                                                                <uc8:usrGender ID="ddlGenderChild5" ValidationGroup="travel_insurance" runat="server" />
                                                            </div>
                                                        </div>
                                                        <div class="clear">
                                                        </div>
                                                    </div>
                                                </div>
                                            </asp:Panel>
                                            <asp:Panel ID="pnlChild6" runat="server" Width="100%">
                                                <div class="seperator">
                                                </div>
                                                <div>
                                                    <h3>
                                                        Child 6</h3>
                                                    <div class="h10">
                                                    </div>
                                                    <div class="w43per left">
                                                        <div id="divChildName6">
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Name:</div>
                                                            <div class="left pad_6t">
                                                                <asp:TextBox ID="txtChildName6" MaxLength="50" runat="server" Width="200px"></asp:TextBox>
                                                                <asp:RequiredFieldValidator ID="rfvChildName6" runat="server" CssClass="validationErrorControl"
                                                                    ErrorMessage="" ValidationGroup="travel_insurance" ControlToValidate="txtChildName6"></asp:RequiredFieldValidator>
                                                                <asp:RegularExpressionValidator ID="revChildName6" runat="server" ControlToValidate="txtChildName6"
                                                                    ValidationExpression="^[a-zA-Z''-'\s]{1,50}$" ValidationGroup="travel_insurance"
                                                                    CssClass="validationErrorControl" Text="" ErrorMessage=""></asp:RegularExpressionValidator>
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> NRIC:</div>
                                                            <div class="left">
                                                                <uc4:usrIdNumber ID="ddlChildNRIC6" runat="server" ValidationGroup="travel_insurance" />
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Date of Birth:</div>
                                                            <div class="left">
                                                                <uc2:usrDate ID="ddlChildDOB6" runat="server" ValidationGroup="travel_insurance"
                                                                    IsEnabled="false" />
                                                            </div>
                                                        </div>
                                                    </div>
                                                    <div class="w56per left">
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Nationality:</div>
                                                            <div class="left">
                                                                <uc7:usrNationality ID="ddlChildNationality6" runat="server" ErrorMessage="" ValidationGroup="travel_insurance" />
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Relation Ship:</div>
                                                            <div class="left">
                                                                <uc9:usrRelationship ID="ddlChildRelationship6" runat="server" ErrorMessage="" ValidationGroup="travel_insurance" />
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Gender:</div>
                                                            <div class="left">
                                                                <uc8:usrGender ID="ddlGenderChild6" ValidationGroup="travel_insurance" runat="server" />
                                                            </div>
                                                        </div>
                                                        <div class="clear">
                                                        </div>
                                                    </div>
                                                </div>
                                            </asp:Panel>
                                        </div>
                                        <div class="bottom">
                                        </div>
                                    </div>
                                    <div class="seperator">
                                    </div>
                                </asp:Panel>

                                <script type="text/javascript">
                                    IncreaseProgress(70);
                                </script>

                                <div class="hilite" style="display: " id="divPaymentModeHeader">
                                    <div class="top">
                                    </div>
                                    <div class="body_in pad_15x" id="divPaymentMode">
                                        <h1>
                                            Payment Mode</h1>
                                        <div class="seperator">
                                        </div>
                                        <div id="divCreditcard" style="display: ;">
                                            <div id="divNameoftheCard">
                                                <div class="w220 left align_right pad_6t pad_7xr">
                                                    <span class="red">*</span> Cardholder's Name:</div>
                                                <div class="left">
                                                    <asp:TextBox ID="txtNameoftheCard" MaxLength="50" runat="server" size="25"></asp:TextBox>
                                                    <asp:RequiredFieldValidator ID="rfvNameoftheCard" ControlToValidate="txtNameoftheCard"
                                                        ErrorMessage="" ValidationGroup="travel_insurance" CssClass="validationErrorControl"
                                                        runat="server"></asp:RequiredFieldValidator>
                                                </div>
                                            </div>
                                            <div class="h10">
                                            </div>
                                            <div id="divIssuingBank">
                                                <div class="w220 left align_right pad_6t pad_7xr">
                                                    <span class="red">*</span> Issuing Bank:</div>
                                                <div class="left">
                                                    <asp:TextBox ID="txtIssuingBank" MaxLength="50" runat="server" size="25"></asp:TextBox>
                                                    <asp:RequiredFieldValidator ID="rfvIssuingBank" ControlToValidate="txtIssuingBank"
                                                        ErrorMessage="" ValidationGroup="travel_insurance" CssClass="validationErrorControl"
                                                        runat="server"></asp:RequiredFieldValidator>
                                                </div>
                                            </div>
                                            <div class="h10">
                                            </div>
                                            <div id="divCardNo">
                                                <div class="w220 left align_right pad_6t pad_7xr">
                                                    <span class="red">*</span> Credit Card Number:</div>
                                                <div class="left">
                                                    <asp:TextBox ID="txtCardNo1" runat="server" MaxLength="4" size="8"></asp:TextBox>
                                                    <asp:TextBox ID="txtCardNo2" runat="server" MaxLength="4" size="8"></asp:TextBox>
                                                    <asp:TextBox ID="txtCardNo3" runat="server" MaxLength="4" size="8"></asp:TextBox>
                                                    <asp:TextBox ID="txtCardNo4" runat="server" MaxLength="4" size="8"></asp:TextBox>
                                                    <asp:RequiredFieldValidator ID="rfvCardNo1" ControlToValidate="txtCardNo1" ErrorMessage=""
                                                        ValidationGroup="travel_insurance" CssClass="validationErrorControl"
                                                        runat="server"></asp:RequiredFieldValidator>
                                                    <asp:RegularExpressionValidator ID="revCardNo1" runat="server" CssClass="validationErrorControl"
                                                        ErrorMessage="" ValidationGroup="travel_insurance" ValidationExpression="[0-9]{4}"
                                                        ControlToValidate="txtCardNo1"></asp:RegularExpressionValidator>
                                                    <asp:RequiredFieldValidator ID="rfvCardNo2" ControlToValidate="txtCardNo2" ErrorMessage=""
                                                        ValidationGroup="travel_insurance" CssClass="validationErrorControl"
                                                        runat="server"></asp:RequiredFieldValidator>
                                                    <asp:RegularExpressionValidator ID="revCardNo2" runat="server" CssClass="validationErrorControl"
                                                        ErrorMessage="" ValidationGroup="travel_insurance" ValidationExpression="[0-9]{4}"
                                                        ControlToValidate="txtCardNo2"></asp:RegularExpressionValidator>
                                                    <asp:RequiredFieldValidator ID="rfvCardNo3" ControlToValidate="txtCardNo3" ErrorMessage=""
                                                        ValidationGroup="travel_insurance" CssClass="validationErrorControl"
                                                        runat="server"></asp:RequiredFieldValidator>
                                                    <asp:RegularExpressionValidator ID="revCardNo3" runat="server" CssClass="validationErrorControl"
                                                        ErrorMessage="" ValidationGroup="travel_insurance" ValidationExpression="[0-9]{4}"
                                                        ControlToValidate="txtCardNo3"></asp:RegularExpressionValidator>
                                                    <asp:RequiredFieldValidator ID="rfvCardNo4" ControlToValidate="txtCardNo4" ErrorMessage=""
                                                        ValidationGroup="travel_insurance" CssClass="validationErrorControl"
                                                        runat="server"></asp:RequiredFieldValidator>
                                                    <asp:RegularExpressionValidator ID="revCardNo4" runat="server" CssClass="validationErrorControl"
                                                        ErrorMessage="" ValidationGroup="travel_insurance" ValidationExpression="[0-9]{4}"
                                                        ControlToValidate="txtCardNo4"></asp:RegularExpressionValidator>
                                                    <asp:CustomValidator CssClass="validationErrorControl" ControlToValidate="txtCreditCardValid"
                                                        ValidationGroup="travel_insurance" ID="csvCreditCardValid" runat="server" ErrorMessage="Credit Card number not valid."
                                                        Text="" OnServerValidate="csvCreditCardValid_ServerValidate"></asp:CustomValidator>
                                                    <span style="display: none">
                                                        <asp:TextBox ID="txtCreditCardValid" Text="Valid" runat="server"></asp:TextBox>
                                                    </span>
                                                </div>
                                            </div>
                                            <div class="h10">
                                            </div>
                                            <div id="divCardExpiry">
                                                <div class="w220 left align_right pad_6t pad_7xr">
                                                    <span class="red">*</span> Card Expiry Date:</div>
                                                <div class="left">
                                                    <asp:DropDownList ID="ddlCardExpiryMonth" runat="server">
                                                        <asp:ListItem Selected="True" Value="-1">mm</asp:ListItem>
                                                        <asp:ListItem Value="01">01</asp:ListItem>
                                                        <asp:ListItem Value="02">02</asp:ListItem>
                                                        <asp:ListItem Value="03">03</asp:ListItem>
                                                        <asp:ListItem Value="04">04</asp:ListItem>
                                                        <asp:ListItem Value="05">05</asp:ListItem>
                                                        <asp:ListItem Value="06">06</asp:ListItem>
                                                        <asp:ListItem Value="07">07</asp:ListItem>
                                                        <asp:ListItem Value="08">08</asp:ListItem>
                                                        <asp:ListItem Value="09">09</asp:ListItem>
                                                        <asp:ListItem Value="10">10</asp:ListItem>
                                                        <asp:ListItem Value="11">11</asp:ListItem>
                                                        <asp:ListItem Value="12">12</asp:ListItem>
                                                    </asp:DropDownList>
                                                    <asp:DropDownList ID="ddlCardExpiryYear" runat="server">
                                                    </asp:DropDownList>
                                                    <asp:RequiredFieldValidator ID="rfvCardExpiryMonth" ControlToValidate="ddlCardExpiryMonth"
                                                        ErrorMessage="" ValidationGroup="travel_insurance" InitialValue="-1" Text=""
                                                        CssClass="validationErrorControl" runat="server"></asp:RequiredFieldValidator>
                                                    <asp:RequiredFieldValidator ID="rfvCardExpiryYear" ControlToValidate="ddlCardExpiryYear"
                                                        ErrorMessage="" ValidationGroup="travel_insurance" InitialValue="-1" Text=""
                                                        CssClass="validationErrorControl" runat="server"></asp:RequiredFieldValidator>
                                                    <asp:CustomValidator CssClass="validationErrorControl" ControlToValidate="txtCCExpiredValid"
                                                        ValidationGroup="travel_insurance" ID="csvCCExpiredValid" runat="server" ErrorMessage="Credit Card expire not valid."
                                                        Text="" OnServerValidate="csvCCExpiredValid_ServerValidate"></asp:CustomValidator>
                                                    <span style="display: none">
                                                        <asp:TextBox ID="txtCCExpiredValid" Text="Valid" runat="server"></asp:TextBox>
                                                    </span>
                                                </div>
                                            </div>
                                            <div class="h10">
                                            </div>
                                            <div id="divCardType">
                                                <div class="w220 left align_right pad_6t pad_7xr">
                                                    <span class="red">*</span> Card Type:</div>
                                                <div class="left">
                                                    <span id="divVisa">
                                                        <asp:RadioButton onclick="ValCheckCardType();CheckCardTypeValidationCss();" ID="rdoVisa"
                                                            runat="server" GroupName="cardtype" />
                                                        &nbsp;<asp:Label class="pad_10xr" ID="lblVisa" runat="server" Text="VISA"></asp:Label>
                                                    </span><span id="divMasterCard">
                                                        <asp:RadioButton onclick="ValCheckCardType();CheckCardTypeValidationCss();" ID="rdoMasterCard"
                                                            runat="server" GroupName="cardtype" />
                                                        &nbsp;<asp:Label ID="lblMasterCard" runat="server" Text="MasterCard"></asp:Label>
                                                    </span>
                                                    <div style="display: none">
                                                        <asp:TextBox ID="txtCardType" runat="server"></asp:TextBox>
                                                    </div>
                                                    <asp:RequiredFieldValidator ID="rfvCardType" runat="server" CssClass="validationErrorControl"
                                                        Display="Dynamic" ErrorMessage="" ControlToValidate="txtCardType" ValidationGroup="travel_insurance"
                                                        Text=""></asp:RequiredFieldValidator>
                                                    <div class="clear">
                                                    </div>
                                                    <em class="note">(Only VISA or Master Credit Card is acceptable for premium payment)</em>
                                                </div>
                                            </div>
                                        </div>
                                        <div class="seperator">
                                        </div>
                                        <p>
                                            I hereby authorise Liberty Insurance Pte Ltd to debit my credit card account as
                                            specified above.</p>
                                        <div class="h7">
                                        </div>
                                        <p>
                                            <b>Coverage</b> for person engaged in professional, administrative, managerial,
                                            clerical and non-manual work solely in offices or similar non-hazardous places</p>
                                        <div class="h7">
                                        </div>
                                        <p>
                                            <b>PAYMENT BEFORE COVER WARRANTY (Individual) </b>
                                            <br />
                                            Please note that the total premium must be paid and actually received in full by
                                            the Company (or the intermediary through whom this Policy was effected) on or before
                                            the inception date of the coverage, failing which the Policy shall be deemed to
                                            be automatically cancelled and no benefits whatsoever shall be payable by the Company.
                                        </p>
                                        <div class="h7">
                                        </div>
                                        <p>
                                            <b>PREMIUM PAYMENT WARRANTY (Corporate)</b><br />
                                            Please note that the total premium must be paid and actually received in full by
                                            the Company (or the intermediary through whom this Policy was effected) within 60
                                            days of the inception date of the coverage, failing which the Policy shall be deemed
                                            to be automatically cancelled and a prorata premum is to be charged for the period
                                            that the Company is on risk.
                                        </p>
                                    </div>
                                    <div class="bottom">
                                    </div>
                                </div>
                                <div class="seperator">
                                </div>
                                <div class="norm" id="divDeclarationHeader">
                                    <div class="top">
                                    </div>
                                    <div class="body">
                                        <div class="pad_15x">
                                            <h1>
                                                Declaration</h1>
                                            <div class="seperator">
                                            </div>
                                            <div>
                                                <p>
                                                    I DO HEREBY DECLARE AND WARRANT the answers given above in every respect are true
                                                    and correct and I have not withheld any information likely to affect acceptance
                                                    of this Proposal, and agree that this Proposal Declaration shall be the basis of
                                                    the Contract between the Company and myself, and I further agree to accept the Company�s
                                                    Policy subject to the terms, exclusions and conditions to be expressed therein,
                                                    endorsed thereon or attached thereto.
                                                </p>
                                                <div class="h10">
                                                </div>
                                                <p>
                                                    I DO HEREBY DECLARE that I am in good health and free from any physical impairment
                                                    or deformity. I will give notice to the Company of any changes in health and occupation
                                                    of the person(s).
                                                </p>
                                            </div>
                                        </div>
                                    </div>
                                    <div class="bottom">
                                    </div>
                                </div>
                                <div class="seperator">
                                </div>
                                <div class="center align_center" id="divFormButtons">
                                    <asp:ImageButton ID="ibtSubmit" runat="server" ValidationGroup="travel_insurance"
                                        OnClientClick="LoadValidationErrorCss();CheckOptionValidationCss();" ImageUrl="~/images/forms_proposal/button/submit.png"
                                        OnClick="ibtSubmit_Click" class="button" />
                                    <asp:Label ID="lblMessage" runat="server" ForeColor="Red"></asp:Label>
                                    <div class="note">
                                        <img src="/images/forms_proposal/icon/warning.png" width="21" height="18" alt="Note"
                                            style="vertical-align: middle; padding-bottom: 3px" />
                                        <strong>Note</strong>, by clicking on the SUBMIT button you agree to our Website's
                                        <a href="../../terms/terms.aspx" target="_blank">Terms &amp; Conditions</a>
                                    </div>
                                </div>
                            </div>
                        </div>
                        <div class="bottom">
                        </div>
                    </div>
                </div>
                <div class="seperator">
                </div>
            </div>
        </div>
    </div>

    <script type="text/javascript">
        IncreaseProgress(90);
    </script>

    <div id="footer">
        <div id="nav_bottom" class="pad_7t">
            <div class="left pad_8yr">
                <asp:ImageButton ID="ImageButton1" runat="server" ImageUrl="/images/forms_proposal/button/back.png"
                    OnClick="imgbtnBackTop_Click" OnClientClick="return confirm('Are you sure to go back?');" />
            </div>
            <div class="right pad_8yr">
                <a href="#" onclick="window.print()">
                    <img src="/images/forms_proposal/button/print.png" alt="Print" /></a>
            </div>
        </div>
    </div>

    <script type="text/javascript">

        function ShowHideDiv(divName, varOnOff) {
            if (varOnOff) {
                document.getElementById(divName).style.display = "";
            }
            else {
                document.getElementById(divName).style.display = "none";
            }

        }


        function CheckOptionValidationCss() {

            CheckCardTypeValidationCss();
        }

        function CheckValidationCss(divYes, divNo, ctrlText, valCtrl) {
            ShowValidationEffectOption(divYes, divNo, ctrlText, valCtrl);
            return true;
        }

        function CheckValidationCssThree(div1, div2, div3, ctrlText, valCtrl) {
            ShowValidationEffectOptionThree(div1, div2, div3, ctrlText, valCtrl);
            return true;
        }

        function CheckValidationCssFour(div1, div2, div3, div4, ctrlText, valCtrl) {
            ShowValidationEffectOptionFour(div1, div2, div3, div4, ctrlText, valCtrl);
            return true;
        }

        function CheckCardTypeValidationCss() {
            CheckValidationCss('divVisa', 'divMasterCard', '<%=txtCardType.ClientID%>', '<%=rfvCardType.ClientID%>');
        }

        function ValCheckCardType(varOnOff) {
            var txtCtrl = document.getElementById("<%=txtCardType.ClientID%>");
            txtCtrl.value = "1";
        }

        function showhide(el) {

            el = document.getElementById(el);
            el.style.display = (el.style.display == "none") ? "block" : "none";

        }

        window.onload = function() {
            //showhide('divDeclaration');
            //showhide('divPaymentMode');
            //showhide('divInsured');
            showhide('divInsurer');
            CheckedChanged();

            if (document.getElementById('<%=txtCardType.ClientID%>').value == "1") {
                ShowHideDiv('divPaymentMode', true);
            }
            else { ShowHideDiv('divPaymentMode', true); }

        }

        function restrictToNumbers(e) {
            if ([e.keyCode || e.which] == 8 || [e.keyCode || e.which] == 37 || [e.keyCode || e.which] == 9 || [e.keyCode || e.which] == 39) //this is to allow backspace
                return true;

            if ([e.keyCode || e.which] < 48 || [e.keyCode || e.which] > 57)
                e.preventDefault ? e.preventDefault() : e.returnValue = false;
        }

        function requestByPostCode() {
            try {
                var _pcode = document.getElementById('<%=txtPostCode.ClientID%>').value;
                if (_pcode.length != 6) {
                    alert('Postal code length must be 6 numbers value.');
                    document.getElementById('<%=txtAddress.ClientID%>').value = '';
                    return false;
                }
                else {
                    requestData(_pcode);
                }
            }
            catch (e) {
                alert(e.toString());
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        function set_data(json) {
            try {
                var srcTable = $("#divAddress").empty();
                var txtAddress = document.getElementById('<%=txtAddress.ClientID%>');
                if (json == null) {
                    $("<table><tr><td>No address found!</td></tr></table>").appendTo(srcTable);
                    alert("No address found!");
                    document.getElementById('<%=txtPostCode.ClientID%>').value = "";
                    txtAddress.value = "No Address found.";
                    return;
                }
                if (json.length == 0) {
                    $("<table><tr><td>No address found!</td></tr></table>").appendTo(srcTable);
                    alert("No address found!");
                    document.getElementById('<%=txtPostCode.ClientID%>').value = "";
                    txtAddress.value = "No Address found.";
                    return;
                }

                var tbl = $("<table width='50%'>");

                var tbody = $("<tbody>");
                var no = 1;
                for (var i = 0; i < json.length; i++) {
                    var trow = $("<tr>"), rec = json[i];
                    if (rec.t != null) {

                        var ctn = rec.t + "<br>" + rec.a;

                        //$("<td>").text(no).data("col", 1).appendTo(trow);
                        $("<td>").html(ctn).data("col", 2).appendTo(trow);
                        if (i == 0) {
                            txtAddress.value = rec.t + "\n" + rec.a;
                        }
                        else {
                            txtAddress.value += "\n\n" + rec.t + "\n" + rec.a;
                        }
                        no++;
                    }
                    trow.appendTo(tbody);
                }
                tbody.appendTo(tbl);
                //alert(srcTable);
                tbl.appendTo(srcTable);
            }
            catch (e) {
                alert(e.toString());
            }
        }

        function PostCodeChange() {
            document.getElementById('divAddress').innerHTML = "Your postcode changed.";
            document.getElementById('divAddress').style.display = 'none';
            document.getElementById('<%=txtAddress.ClientID%>').innerHTML = "Your postcode changed.\nGetting address from street directory...";
        }

        IncreaseProgress(100);
        HideLoading();
    </script>

<script src="../../includes/travelinsurance/liberty.proposalform.js" type="text/javascript"></script>
</asp:Content>
